This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hébert-Croteau, N. Articles by Deschênes, L. Search for Related Content PubMed PubMed Citation Articles by Hébert-Croteau, N. Articles by Deschênes, L. Social Bookmarking                            What's this?

Time Trends in Systemic Adjuvant Treatment for Node-Negative Breast Cancer

From the Direction de la Santé Publique, Régie Régionale de la Santé et des Services Sociaux de Montréal-Centre; Centre d'Oncologie, Centre Hospitalier de l'Université de Montréal, Campus Hôtel-Dieu; Département de Pathologie, Centre Hospitalier de l'Université de Montréal, Campus Saint-Luc, Montréal; Groupe de Recherche en Épidémiologie de l'Université Laval, Hôpital du Saint-Sacrement; and Département de Chirurgie, Hôpital du Saint-Sacrement, Québec, Canada.

Address reprint requests to Nicole Hébert-Croteau, MD, PhD, Direction de la santé publique de Montréal-Centre, 4835, ave Christophe-Colomb, Montréal, Québec, H2J 3G8 Canada; email ncroteau{at}santepub-mtl.qc.ca

PURPOSE: We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer.

MATERIALS AND METHODS: A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations.

RESULTS: Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor–negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines.

CONCLUSION: Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. J. Hassett, M. E. Hughes, J. C. Niland, S. B. Edge, R. L. Theriault, Y.-N. Wong, J. Wilson, W. B. Carter, D. W. Blayney, and J. C. Weeks Chemotherapy Use for Hormone Receptor-Positive, Lymph Node-Negative Breast Cancer J. Clin. Oncol., December 1, 2008; 26(34): 5553 - 5560. [Abstract] [Full Text] [PDF]

				J. J. Doyle, A. I. Neugut, J. S. Jacobson, V. R. Grann, and D. L. Hershman Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study J. Clin. Oncol., December 1, 2005; 23(34): 8597 - 8605. [Abstract] [Full Text] [PDF]

				J. N. Cormier, Y. Xing, M. Ding, J. E. Lee, P. F. Mansfield, J. E. Gershenwald, M. I. Ross, and X. L. Du Population-Based Assessment of Surgical Treatment Trends for Patients With Melanoma in the Era of Sentinel Lymph Node Biopsy J. Clin. Oncol., September 1, 2005; 23(25): 6054 - 6062. [Abstract] [Full Text] [PDF]

				R. A. Silliman Crossing the Quality Chasm in Breast Cancer Care J. Clin. Oncol., September 15, 2004; 22(18): 3654 - 3656. [Full Text] [PDF]

				N. Hebert-Croteau, J. Brisson, J. Latreille, M. Rivard, N. Abdelaziz, and G. Martin Compliance With Consensus Recommendations for Systemic Therapy Is Associated With Improved Survival of Women With Node-Negative Breast Cancer J. Clin. Oncol., September 15, 2004; 22(18): 3685 - 3693. [Abstract] [Full Text] [PDF]

				N. Hebert-Croteau, J. Brisson, J. Latreille, C. Blanchette, and L. Deschenes Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994 Can. Med. Assoc. J., October 1, 1999; 161(8): 951 - 955. [Abstract] [Full Text] [PDF]